Iowa Specialty Hospital- Clarion
Organization Active NPI Rural Health Clinic/Center · Clarion, IA
NPI 1396792008 · NPPES record last updated Dec 10, 2019
Key facts
- NPI
- 1396792008
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 990177H (IA)
- Legal business name
- IOWA SPECIALTY HOSPITAL- CLARION
- Practice address
- 215 13TH Ave SW
Clarion, IA 50525-2078 - Phone
- (515) 532-2836
- Fax
- (515) 532-2523
- NPI assigned
- May 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Steve Simonin
- Title
- Ceo
- Phone
- (515) 532-9333
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 21
Related certifications (CCN) 1
Practitioners 8
-
Amber Lee Campbell, APRN
-
Tori Nichole Dow, LMHC
-
Kelly Langfitt, LMSW
-
Amy Larson, ARNP
-
Marissa Marie Larson, LISW
-
Alice Meng, MD
-
Daniel Touney, ARNP
-
Michael Travis Pierce, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Rural health clinic certification: CCN 163495
- Legal name
- IOWA SPECIALTY HOSPITAL- CLARION
- Doing business as
- CLARION CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 1, 2003
- Last certification
- Jun 1, 2022
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Enrollment address
- 215 13TH Ave SW
Clarion, IA 50525-2078 - Related CCNs
- 161302
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Gregory C Polzin |
Corporate Director | Jul 22, 2013 | |
| Sherri Obrien |
Corporate Director | Jun 29, 2021 | |
| Katrina Stecher |
Corporate Director | Oct 11, 2017 | |
| Judith a Ritter |
Corporate Director | Oct 11, 2017 | |
| Missy Brannick |
W-2 Managing Employee | Oct 11, 2017 | |
| Sue Martin |
Corporate Director | Oct 11, 2017 | |
| Steven J Simonin |
Corporate Officer | Jul 22, 2013 | |
| Anthony Meinke |
Corporate Director | Oct 29, 2019 | |
| Kelly J Leu |
W-2 Managing Employee | Oct 11, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030103000013 | IA | Part a Provider - Rural Health Clinic | 3375451347 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clarion, IA |
National Provider Directory
- Tax ID family
- Iowa Specialty Hospital- Clarion
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 990177H | IA | Yes |
Addresses
Primary practice location
215 13TH Ave SW
Clarion, IA 50525-2078
Mailing address
215 13TH Ave SW
Clarion, IA 50525-2078
Phone (515) 532-2836
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0635011 | Medicaid | IA |
Other names
- Clarion Clinic
Other providers in Clarion, IA
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
- Iowa Specialty Hospital- Clarion
All providers in Clarion, IA · Rural Health Clinic/Center in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.